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PubMed2001

Thirteen-year follow-up of children and adolescents with chronic fatigue syndrome.

OBJECTIVE: To describe the educational, social, and symptomatic outcome of children and adolescents with chronic fatigue syndrome 13 years after illness onset. METHODS: Between January 1984 and December 1987, 46 children and adolescents developed an illness suggestive of chronic fatigue syndrome. Follow-up questionnaires were obtained from 35 participants an average of 13 years after illness onset. Data were obtained concerning subsequent medical diagnoses, amount of school missed, presence and severity of current symptoms, and subjective assessment of degree of illness resolution. RESULTS: Of the 35 participants, 24 were female (68.6%) and 11 were male (31.4%). Average age at illness onset was 12.1 years. Eight participants (22.9%) had an acute onset of symptoms, 27 (77.1%) had a gradual onset. No participant received an alternative medical diagnosis that could have explained the symptom complex between illness onset and follow-up. Thirteen participants (37.1%) considered themselves resolved of illness at follow-up; 15 participants (42.9%) considered themselves well but not resolved; 4 (11.4%) considered themselves chronically ill; and 3 (8.6%) considered themselves more ill than during the early years of illness. Correlation with the Medical Outcomes Study Short Form Health Survey was good for current level of symptoms and degree of recovery. Eight participants (22.9%) missed >2 years of school, and 5 of these were still ill at follow-up. Amount of school missed correlated with both illness severity at follow-up and perceived social impact of the illness. CONCLUSIONS: These data demonstrate the presence of an illness consistent with the current definition of chronic fatigue syndrome. Eighty percent of children and adolescents affected had a satisfactory outcome from their fatiguing illness, although the majority of these participants had mild to moderate persisting symptoms. Twenty percent of participants remain ill with significant symptoms and activity limitation 13 years after illness onset. Chronic fatigue syndrome in children and adolescents may result in persistent somatic symptoms and disability in a minority of those affected.

Absenteeism↗
PubMed1996

A longitudinal assessment of hormonal and physical alterations during normal puberty in boys. II. Estrogen levels as determined by an ultrasensitive bioassay.

A limited number of reports of estrogen levels in prepubertal and early pubertal boys have been published because previous estrogen assays have lacked adequate sensitivity to quantitate circulating estrogen concentrations. Development of a new ultrasensitive assay has permitted measurement of estrogen levels in 23 normally growing boys progressing through puberty. Concentrations were measured at approximately 4-month intervals over a 5- to 8-yr period. The levels increased with maturation in all and correlated directly with chronological age, bone age, weight, height, pubertal stage, and testosterone and insulin-like growth factor-I levels. Of these factors, the level of testosterone had the greatest influence on the estrogen concentration. The time from peak growth velocity also significantly correlated with estrogen level. The estrogen level correlated positively with growth velocity before the time of peak growth velocity and negatively after peak growth velocity. The estrogen levels first increased significantly an average of 3 yr after pubertal onset and reached a peak by 5 yr after pubertal onset. Peak growth velocity was attained an average of 3 yr after pubertal onset. The greatest increase in the rate of rise of the estrogen level was an 11-fold rise during the year in which puberty began. The next most significant increase was a 4.8-fold rise 3 yr after pubertal onset. With respect to pubertal stage, the greatest absolute change occurred from stage 4 to stage 5 and the greatest fold change occurred from stage 1 to stage 2. The estrogen level did not significantly correlate with the 24-h GH level. In conclusion, circulating estrogen levels are very low in all boys prepubertally and rise steadily during adolescent development. The estrogen level is closely related to testosterone concentration and to the time of peak growth velocity. These findings are consistent with the hypothesis that estrogen at low levels augments skeletal growth and maturation in boys (as well as girls). They are also consistent with the hypothesis that continued exposure to estrogen leads to epiphyseal fusion. Further studies are required to define the separate and combined roles of estrogen, GH, and testosterone, as well as other factors, on growth and sexual development at puberty.

Age Determination by Skeleton↗
PubMed2005

A clinical rating scale for Batten disease: reliable and relevant for clinical trials.

BACKGROUND: Batten disease (juvenile neuronal ceroid lipofuscinosis [JNCL]) is an autosomal recessive neurodegenerative disorder characterized by blindness, seizures, and relentless decline in cognitive, motor, and behavioral function. Onset is in the early school years, with progression to death typically by late adolescence. Development of a clinical instrument to quantify severity of illness is a prerequisite to eventual assessment of experimental therapeutic interventions. OBJECTIVE: To develop a clinical rating instrument to assess motor, behavioral, and functional capability in JNCL. METHODS: A clinical rating instrument, the Unified Batten Disease Rating Scale (UBDRS), was developed by the authors to assess motor, behavioral, and functional capability in JNCL. Children with verified JNCL were evaluated independently by three neurologists. Intraclass correlation coefficients (ICCs) were used to estimate the interrater reliability for total scores in each domain. Interrater reliability for scale items was assessed with weighted kappa statistics. RESULTS: Thirty-one children with confirmed JNCL (10 boys, 21 girls) were evaluated. The mean age at symptom onset was 6.1 +/- 1.6 years, and the mean duration of illness was 9.0 +/- 4.4 years. The ICCs for the domains were as follows: motor = 0.83, behavioral = 0.68, and functional capability = 0.85. CONCLUSIONS: The Unified Batten Disease Rating Scale (UBDRS) is a reliable instrument that effectively tests for neurologic function in blind and demented patients. In its current form, the UBDRS is useful for monitoring the diverse clinical findings seen in Batten disease.

Adolescent↗
PubMed2002

Injury risk in young people with intellectual disability.

Epidemiological studies have established injury as a major public health problem for young people in the general population, but minimal population-based injury information exists on those with intellectual disability (ID). The present study investigated risk factors for injury to subjects in the Australian Child and Adolescent Development (ACAD) programme, which is examining emotional and behavioural problems in young people with ID. Extensive biopsychosocial data for the ACAD programme were collected at two time intervals (i.e. 1990-1991 and 1995-1996). Carer report of medically attended injury over one year was collected for the first time period (1995-1996) on a sample of 465 ACAD subjects (aged 5-29 years) representative of young people with ID (IQ < 70) to determine risk factors for injury using the ACAD biopsychosocial data. Psychopathology [odds ratio (OR)=3.4] epilepsy (OR = 2.4) and an overly sociable temperament (OR=2.2) are associated with injury in young people with ID. Social and family factors had minimal influence on injury risk in this population. Those who are highly disruptive, self-absorbed, anxious, have problems relating socially, have communication disturbance or have attention deficit hyperactivity symptoms are particularly at increased risk for injury. The present study demonstrates a largely under-recognized public health problem of a high unintentional injury risk for young people with ID, and identifies substantial and important risk factors for injury. Injury prevention programmes, with a particular focus on those with highly disturbed behaviours or epilepsy, are warranted in this population.

Accidents↗
PubMed2001

Injury in young people with intellectual disability: descriptive epidemiology.

OBJECTIVES: To assess the public health importance of injury in a representative sample of young people with intellectual disability relative to the general population. SETTING: This study forms part of the Australian Child and Adolescent Development (ACAD) program examining emotional and behavioural problems in a cohort of young people with intellectual disability (IQ<70). The program has collected extensive biopsychosocial data from carers of subjects at two time intervals, 1990 (n = 579) and 1996 (n = 465). METHOD: Carer report of medically attended injury to subjects was collected for the first time during 1996 (age 5-29 years) and supplemented with medical record injury data from hospitals and general practitioners for 147 of the ACAD sample and 110 supplementary subjects. These data were compared with general population injury data to assess relative epidemiological differences. RESULTS: Annual injury mortality and morbidity rates were 150/100,000 and 55.6/1000 persons, with age standardised mortality and morbidity ratios of 8 and 2 respectively. Males and females had similar injury rates. The rate for injury hospitalisations was twice that of the general population. Falls were more common and transport injury and intentional injury less common causes of injury morbidity compared with general population. The patterns of cause, circumstances, and severity of injury in young people with intellectual disability have more similarities with younger children than with their same age group in the general population. CONCLUSION: This study should alert clinicians and others to the increased risk for injury and possible further handicap in this population. It is essential that injury prevention programs be implemented and evaluated for their effectiveness in reducing the substantial additional burden of suffering, care and cost resulting from injury to young people with intellectual disability.

Accidents↗
PubMed1998

Adolescent childbearing in developing countries: a global review.

This article discusses the current levels and recent trends in the rate of adolescent childbearing, the timing of the first birth, and births to unmarried women for 43 developing countries. Differences in rates of adolescent childbearing by residence and level of education are also examined. The analysis is based on nationally representative fertility surveys. Substantial declines in adolescent fertility have occurred in North Africa and Asia, but levels are still high in some countries. Declines are beginning to occur in sub-Saharan Africa, but current levels are still high in most countries of this region, and the proportion of births to unmarried adolescents is increasing in some countries. In Latin America, where the level of teenage childbearing is moderate, declines are less prevalent and some small increases have occurred. Higher education is associated with lower rates of adolescent childbearing, but other socioeconomic changes cancel or reduce this effect in several countries.

Adolescent↗
PubMed2005

Growth and nutritional status of male adolescent laborers in Ankara, Turkey.

Undernutrition, pathogenic agents, and poor living conditions are of primary importance in the evaluation of adverse environmental conditions' effects on human growth; but child labor (an equally significant factor, especially in underdeveloped countries) is generally overlooked or ignored. The aim of this study is to focus on this subject and clarify the effects of labor on the physical growth and nutritional status of child and adolescent laborers. In this study, the height and weight of 532 male adolescent laborers aged 13.5-18.5 years and their non-laboring peers (n = 451) (the control group) were measured by standard anthropometric techniques and equipment. The individuals of both groups come from lower socioeconomic strata and share similar living conditions. Data were transformed to z-scores, using the US Center for Disease Control and Prevention's 2000 growth charts. The analyses show that the z-scores for height-for-age, weight-for-age, and body mass index (BMI)-for-age were negative in both groups. The z-scores of laborers' height-for-age and weight-for-age values lie below the controls', but there is no significant difference between the two groups' BMI-for-age scores. In the laboring group, the percentages of stunting (-2 SD of height-for-age), underweight (-2 SD of weight-for-age), and wasting (-2 SD of BMI-for-age) were 14.3, 2.6, and 0.2, respectively. These values suggest that malnutrition is not a common problem among adolescent laborers living in Ankara; but laboring is an important cause of faltering in growth, particularly in linear growth, in less or underdeveloped economic environments.

Adolescent↗
PubMed2006

Clinical action: introduction to the special section on the action perspective in clinical psychology.

Action theory (AT) is an emerging theoretical and empirical paradigm that is based on multiple perspectives. The common denominator of these perspectives is their depiction of the individual as actively shaping his or her interpersonal environment. The purpose of this special section is to evaluate the impact of AT on clinical psychology. To that effect, articles that focus on a broad range of topics, including stress and depression, chronic pain, child and adolescent development, clinical case formulation, psychotherapy for suicidal patients, and public mental health policy in relation to recovery from psychosis have been assembled. Presenting novel conceptualizations and data on the ways in which individuals actively shape their environment, these articles highlight the potential of AT for improving clinical science and practice.

Humans↗
PubMed1995

Quinolone-induced arthropathy in the neonatal mouse. Morphological analysis of articular lesions produced by pipemidic acid and ciprofloxacin.

Quinolone antibiotics are extensively utilized in antimicrobial chemotherapy. However, quinolone treatment in developing adolescents of several animal species is associated with acute arthropathy of the weight-bearing joints. Although arthropathy has rarely been observed following quinolone therapy in man, the toxicity observed in immature animals has resulted in restricted use of these drugs in children and pregnant women. Therefore, identification of novel quinolone antibiotics which do not cause arthropathy is highly desirable. This task would be facilitated by a bioassay of cartilage toxicity which utilizes small quantities of test material and has greater sensitivity than current toxicity assays. This study evaluated the utility of neonatal mice as a potential bioassay of quinolone-induced joint toxicity. Seven-day-old CF-1 mice (8-10/dose group) were treated subcutaneously with either pipemidic acid (50, 400, or 3150 mg/kg/day) for 7 or 14 days or ciprofloxacin (50 or 200 mg/kg/day) for 5, 7, or 14 days. Lameness was observed only after high-dose pipemidic acid treatment for 2-7 days. Histopathological assessment of the principal weight-bearing joints (knee, elbow, and multiple articulations in the fore- and hind-feet) revealed a lesion characterized by chondrocyte loss, matrix degeneration, and erosion of the articular cartilage in mice treated with pipemidic acid at 400 or 3150 mg/kg/day for 7 days or ciprofloxacin at 200 mg/kg/day for 5 days. Mice treated for 14 days with 400 mg/kg/day pipemidic acid demonstrated a lower incidence of lesions than mice treated for 7 days, suggesting the potential for reversibility during ongoing treatment. The results suggest that neonatal mice are sensitive to quinolone-induced arthropathy, but less so than previously reported for adolescent dogs. It is concluded that the neonatal mouse may be an appropriate screening system for identifying novel quinolones devoid of cartilage toxicity; however, follow-up studies with select compounds in a more sensitive species, such as the dog, are encouraged.

Animals↗
PubMed1985

Genetics and aging; the Werner syndrome as a segmental progeroid syndrome.

The maximum lifespan potential is a constitutional feature of speciation and must be subject to polygenic controls acting both in the domain of development and in the domain of the maintenance of macromolecular integrity. The enormous genetic heterogeneity that characterizes our own species, the complexities of numerous nature-nurture interactions, and the quantitative and qualitative variations of the senescent phenotype that are observed suggest that precise patterns of aging in each of us may be unique. Patterns of aging may also differ sharply among species (for example, semelparous vs. multiparous mammals). Some potential common denominators, however, allow one to identify progeroid syndromes in man that could lead to the elucidation of important pathways of gene action. (The suffix "-oid" means "like"; it does not mean identity.) Unimodal progeroid syndromes (eg., familial dementia of the Alzheimer type, an autosomal dominant) can help us understand the pathogenesis of a particular aspect of the senescent phenotype of man. Segmental progeroid syndromes (eg. the Werner syndrome, an autosomal recessive) may be relevant to multiple aspects of the senescent phenotype. Some results of research on the Werner syndrome may be interpreted as support for "peripheral" as opposed to "central" theories of aging; they are consistent with the view that gene action in the domain of development (adolescence, in this instance) can set the stage for patterns of aging in the adult; they point to the importance of mesenchymal cell populations in the pathogenesis of age-related disorders; finally, they underscore the role of chromosomal instability, especially in the pathogenesis of neoplasia.

Aging↗
PubMed2007

An investigation of the behavioral actions of ethanol across adolescence in mice.

RATIONALE: The transition from adolescence into adulthood is characterized by rapid maturation of brain systems mediating reward and by increasing experimentation with drugs of abuse including ethanol (EtOH). Previous studies have found marked differences in sensitivity to the behavioral effects of EtOH in adolescent rats as compared to adults, but relatively few studies have been conducted in mice. OBJECTIVES: The present study examined sensitivity to various behavioral effects of EtOH in C57BL/6J mice at various stages of adolescence/adulthood (4, 6, 8 weeks old). Ages were compared for locomotor stimulant (open field), anxiolytic-like (elevated plus-maze), memory-impairing (Pavlovian fear conditioning) and ataxic (accelerating rotarod) effects of EtOH, and the sedative/hypnotic (sleep time) effects of EtOH and pentobarbital. EtOH self-administration was compared using a two-bottle choice paradigm. Measures of EtOH metabolism were also obtained. RESULTS: Early adolescent mice exhibited increased sensitivity to locomotor stimulant (1.5 g/kg), anxiolytic-like (1.5 g/kg) and ataxic (1.5-2.5 g/kg), but not memory impairing (2.0 g/kg), effects of EtOH relative to adults. Early adolescent, and to some extent peri-adolescent, mice were less sensitive than adults to the sedative/hypnotic effects of EtOH (3.5-4.5 g/kg), but not pentobarbital (40-50 mg/kg). Early adolescent mice showed lower EtOH preference, but not EtOH consumption, than adults. Blood EtOH concentrations were higher at early time points and lower at later time points after (3.0 g/kg) EtOH injection in early and peri-adolescents relative to adults. CONCLUSIONS: Present data demonstrate that sensitivity to the acute intoxicating effects of EtOH changes across mouse adolescent development in a behavior-dependent manner.

Age Factors↗
PubMed2005

Obesity in the United States: is there a quick fix? Pros and cons of bariatric surgery from the pediatric perspective.

Bariatric surgery has become a standard of care for the treatment of severely obese adults who meet National Institutes of Health criteria. Unfortunately, there is a need for weight loss surgery in adolescents. Criteria developed for adolescents are generally more restrictive than those for adults due to concerns about the ability of children to consent for life-altering surgery and the lack of long-term results. Several preliminary series have reported adolescent bariatric procedures with promising results. The two primary bariatric procedures performed on adolescents are Roux-en-Y gastric bypass (RYGB) and adjustable gastric banding (AGB). Each procedure has its advantages and disadvantages. RYGB has the longest follow-up results and is considered the "gold standard." AGB has promising results, is reversible, and can be performed with less morbidity and mortality.

Adolescent↗
PubMed1984

The drug problem in The Netherlands.

In the Netherlands, the drug problem among adolescents developed as a new phenomenon in the mid 1960s. Without remarkable success, methadone maintenance programs were introduced in 1968. Drug free treatment in therapeutic communities, developed since 1972, was successful after the first experimental years. This success provoked the illusion that drug related problems could be solved by treatment; low threshold programs, putting few demands on participants, were established to dispense methadone. The illusion was that addicts can be motivated into further treatment if they are brought into contact with professionals. As the addict population kept growing and their street crimes increased in number, Dutch drug policies changed in 1978, using methadone as a means to decrease criminal activities rather than to treat addicts. This also turned out to be an illusion. Currently, there is strong political pressure to distribute heroin to addicts to diminish the negative side effects of drug abuse. Dutch drug policies are characterized by the opinion that drug problems cannot be solved and have to be accepted.

Day Care, Medical↗
PubMed2006

Forensic psychiatric inpatient treatment: creating a therapeutic milieu.

A functional therapeutic milieu in an adolescent forensic unit comprises far more elements than effective psychosocial treatments alone. In the psychosocial domain, this article discusses principles of therapeutic community, structure, predictability, therapeutic aggression management, and family work. A core element in all activities of an adolescent forensic unit is finding a balance between security and age-appropriate support for adolescent development.

Forensic Psychiatry↗
PubMed2007

Do readers with autism make bridging inferences from world knowledge?

Individuals with autism frequently show impairments in text reading comprehension. This often is attributed to poor ability to draw inferences during reading and to inadequate access to relevant knowledge. The current study tested this hypothesis by measuring the time taken to read the same question, relating to either physical or social world knowledge, when it was either relevant or irrelevant to the bridging inference evoked by a preceding two-sentence vignette. In the study, 16 normally developing adolescents and 16 adolescents with autism were matched on word reading accuracy, chronological age, and vocabulary but differed significantly in text comprehension. A strong priming effect was found, robust over participants and over items; participants read those questions that were relevant to the inference evoked by the vignette faster than they read those questions that were irrelevant, and no interaction with group membership or type of knowledge was found. This indicates that readers with autism, just like controls, were activating appropriate world knowledge primed by implicit inferences while reading the vignettes. Thus, the comprehension problems in these readers cannot be attributed to an inability to make implicit inferences or to draw on relevant world knowledge. Instead, we suggest that these problems must be sought at a higher level of text processing.

Adolescent↗